Anticipating pulmonary complications after thoracotomy: the FLAM Score

OBJECTIVE: Pulmonary complications after thoracotomy are the result of progressive changes in the respiratory status of the patient. A multifactorial score (FLAM score) was developed to identify postoperatively patients at higher risk for pulmonary complications at least 24 hours before the clinical diagnosis. METHODS: The FLAM score, created in 2002, is based on 7 parameters (dyspnea, chest X-ray, delivered oxygen, auscultation, cough, quality and quantity of bronchial secretions). To validate the FLAM score, we prospectively calculated scores during the first postoperative week in 300 consecutive patients submitted to posterolateral thoracotomy. RESULTS: During the study, 60 patients (20%) developed pulmonary complications during the postoperative period. The FLAM score progressively increased in complicated patients until the fourth postoperative day (mean 13.5 ± 11.9). FLAM scores in patients with complications were significantly higher (p < 0.05) at least 24 hours before the clinical diagnosis of complication, compared to FLAM scores in uncomplicated patients. ROC curves analysis showed that the cut-off value of FLAM with the best sensitivity and specificity for pulmonary complications was 9 (area under the curve 0.97). Based on the highest FLAM scores recorded, 4 risk classes were identified with increasing incidence of pulmonary complications and mortality. CONCLUSION: Changes in FLAM score were evident at least 24 hours before the clinical diagnosis of pulmonary complications. FLAM score can be used to categorize patients according to risk of respiratory morbidity and mortality and could be a useful tool in the postoperative management of patients undergoing thoracotomy

Basal ganglia dysfunction in OCD: subthalamic neuronal activity correlates with symptoms severity and predicts high-frequency stimulation efficacy

Functional and connectivity changes in corticostriatal systems have been reported in the brains of patients with obsessive–compulsive disorder (OCD); however, the relationship between basal ganglia activity and OCD severity has never been adequately established. We recently showed that deep brain stimulation of the subthalamic nucleus (STN), a central basal ganglia nucleus, improves OCD. Here, single-unit subthalamic neuronal activity was analysed in 12 OCD patients, in relation to the severity of obsessions and compulsions and response to STN stimulation, and compared with that obtained in 12 patients with Parkinson's disease (PD). STN neurons in OCD patients had lower discharge frequency than those in PD patients, with a similar proportion of burst-type activity (69 vs 67%). Oscillatory activity was present in 46 and 68% of neurons in OCD and PD patients, respectively, predominantly in the low-frequency band (1–8 Hz). In OCD patients, the bursty and oscillatory subthalamic neuronal activity was mainly located in the associative–limbic part. Both OCD severity and clinical improvement following STN stimulation were related to the STN neuronal activity. In patients with the most severe OCD, STN neurons exhibited bursts with shorter duration and interburst interval, but higher intraburst frequency, and more oscillations in the low-frequency bands. In patients with best clinical outcome with STN stimulation, STN neurons displayed higher mean discharge, burst and intraburst frequencies, and lower interburst interval. These findings are consistent with the hypothesis of a dysfunction in the associative–limbic subdivision of the basal ganglia circuitry in OCD's pathophysiology

The impact of the nelfinavir resistance-conferring mutation D30N on the susceptibility of HIV-1 subtype B to other protease inhibitors

The human immunodeficiency virus type 1 (HIV-1) protease mutation D30N is exclusively selected by the protease inhibitor (PI) nelfinavir and confers resistance to this drug. We demonstrate that D30N increases the susceptibility to saquinavir (SQV) and amprenavir in HIV-1 subtype B isolates and that the N88D mutation in a D30N background neutralizes this effect. D30N also suppresses indinavir (IDV) resistance caused by the M46I mutation. Interestingly, in patients with viruses originally containing the D30N mutation who were treated with IDV or SQV, the virus either reversed this mutation or acquired N88D, suggesting an antagonistic effect of D30N upon exposure to these PIs. These findings can improve direct salvage drug treatment in resource limited countries where subtype B is epidemiologically important and extend the value of first and second line PIs in these populations

STEEL SHEAR PANELS AS RETROFITTING SYSTEM OF EXISTING MULTI-STORY RC BUILDINGS: CASE STUDIES

The seismic retrofitting of existing reinforced concrete buildings is currently a major economic and social activities for the redevelopment of congested urban areas. Innovative reversible technologies by metal devices are capable of protecting buildings from damage, providing high levels of structural safety. The current paper is framed within this context, where steel plate shear walls (SPSWs) as retrofitting system of multi-story residential RC buildings, designed for vertical loads and located in the historic center area of Torre del Greco (Naples, Italy), have been used. The vulnerability analysis performed on the inspected buildings have shown their inability to withstand seismic actions. Therefore, the retrofitting design of such buildings through partial bay and full bay SPSWs has been done. The retrofitted buildings behaviour has been assessed through numerical analysis carried out in the non-linear field. The achieved results have shown a significant improvement of the structural performance of the tested improved buildings in terms of strength and stiffness. As a further research development, the available information on the design of SPSWs for retrofitting existing RC buildings will allow to design useful design charts capable of providing the optimal plate geometric dimensions as a function of predetermined performance targets

QUANTITATIVE RISK ASSESSMENT METHODOLOGY FOR BUILDING SELECTION IN RETROFITTING PROCESS

International audienceSince 2011 French territory has a new seismic zoning including five seismicity areas (very low to high), from which acceleration (PGA) is referring to the design of new buildings with standards Eurocode 8. However seismic regulations apply to existing buildings, often built before its application, only for specific work conditions. With an annual turnover about 2%, the knowledge of existing buildings compliance with seismic design is capital for seismic risk management policy. In this context, the working group of French Association for Earthquake Engineering (AFPS) was interested in defining a quantitative evaluation method of seismic risk and compliance of existing buildings. The proposed methodology considered a large building number application with only basic vulnerability information. The main goal is obtain a large picture for decision making based on risk criteria with identification in a first step high risk buildings and in a second step compliance to seismic standards. This communication presents the general procedure of methodology for risk evaluation steps and compliance standards of existing buildings. Application of methodology to French seismic context is shown through different examples